Wearing a ‘Happy Mask’? You Might Have Concealed Depression

It's possible to be high-functioning on the outside but hurting on the inside.

woman looking through blinds

If you know someone with depression—or experience the condition yourself—you know that the signs and impact it may have on daily life can be profound. Your appetite may suffer, your relationships may be affected, your mood may be hopelessly low and you may literally be unable to get out of bed in the morning.

But did you know that you may have a friend or coworker with depression who shows few or any outward signs of the disease at all—who seems otherwise “normal” and perhaps even “happy”?

It may sound hard to believe, but concealed depression, as this sort of depression is known, is real.

What is concealed depression?

Concealed depression isn’t a separate type of depression; rather, it describes the way a person with depression may be able to hide their symptoms especially well.

Harish Mangipudi, DO, a psychiatrist at Summerville Medical Center in Charleston, South Carolina, explains that concealed depression entails many of the features that are involved in a traditional diagnosis of depression. These depression signs are noticeable to and experienced by the affected individual, but they may be entirely obscured from others.

Those who have concealed depression typically bottle up their thoughts and feelings in an effort to appear “okay” and often appear from the outside to be high-functioning adults.

“Concealed depression is typified by the ‘Happy Mask,’” says marriage and family therapist Bruce Conn of Coliseum Medical Centers in Macon, Georgia. “But inside, this is the silent sufferer of depression who tries to feel better by helping others and keeping up a good front. In reality, they’re exhausted and questioning themselves all the time.”

And they may even fail to reveal their symptoms to their healthcare providers. Among the more than 1,000 Californians polled in a 2011 survey conducted by University of California, Davis researchers, 43 percent said they wouldn’t tell their primary care doctor about their depression symptoms.

Why does concealed depression occur?

Flip through the channels on your television or take a look through your social media feed, and it’s obvious we live in a world that encourages only the highlights of life to be shared. It’s understandable, then, that people with depression may feel alone and that they need to conceal their problems.

They may do so because they don’t want to worry or burden others with their condition. They may also feel like they can’t be helped. Or they may think that no one will understand what they’re going through.

It’s important to remember that clinical depression, or major depressive disorder, can be extremely dangerous if not managed. Depression can cause powerful changes in mood and, in extreme circumstances, may lead to thoughts of death or suicide.

Are symptoms of concealed depression different?

Symptoms of concealed depression are similar to those of major depressive disorder. According to the National Institute of Mental Health, a diagnosis of depression would involve experiencing some of the following signs nearly every day for at least two weeks:

  • Persistent sadness, anxiety or feelings of emptiness
  • Pessimism and low self-esteem
  • Feelings of isolation
  • Irritability
  • Feelings of guilt
  • Exhaustion or low levels of energy
  • Restlessness
  • Trouble concentrating or making important decisions
  • Sleep problems
  • Weight gain or loss
  • Suicide attempts

Because those with concealed depression tend to hide symptoms, it can be difficult for loved ones to recognize these signs and offer help.

If you notice someone is showing any signs of depression, Conn recommends talking to them in person, asking them how they are doing and waiting for the answer.

“You can make the investment by listening,” he says. “Once they answer, follow up by saying something like, ‘Do you want to tell me more about that?’”

You may find they’ll open up and share more of what they’re going through.

There are many ways to get help

Depression can occur for many different reasons. Sometimes a life crisis can bring it on, but sometimes the condition can arise for no apparent reason.

Regardless of the onset, it’s important for those who are experiencing any form of depression to realize it’s not their fault and to get help. And if you are experiencing any symptoms of depression—even if you’re able to otherwise put on a brave face and make it through the day—take those signs seriously and seek help from a professional.

After an official diagnosis, a mental health professional can help you come up with a treatment plan that’s right for you. The goal of treatment is to determine any stressors in your life that may be contributing to depression and to help you better handle difficult feelings and situations.

 Some of the most common treatment methods include:

  • Psychotherapy such as cognitive behavioral therapy or interpersonal therapy
  • Medications like antidepressants, mood stabilizers and antipsychotics
  • Electroconvulsive therapy may also be helpful in cases where depression is resistant to other modes of treatment

Your doctor may also recommend supportive strategies, including:

  • Regular exercise to help improve mood
  • Light therapy, a treatment that utilizes a light box in order to normalize melatonin levels

Dr. Mangipudi also recommends getting adequate amounts of sleep, eating a proper diet and keeping in touch with friends and loved ones if you’re dealing with depression.

If you or someone you know is feeling suicidal, call the National Suicide Prevention Lifeline at 1-800-273-8255 or call, text, or chat 988. Or, call 911 in case of immediate danger.

“Depression is real and not just ‘in one’s head,’" says Mangipudi. “If you feel chronically depressed, seek out help. There are resources and professionals who want to help."

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Types of Depression: Don't Let the Blues Beat You

If you've experienced blue moods, you know the toll they can take on your personal and professional life. But did you know that depression can have a negative impact on your health? It's true: Depression affects not only your thinking but also your sleep, your appetite, your immune system, and other natural processes that help keep your mind and body in good working order.

In fact, depression has been linked to hypertension, stroke, heart disease, diabetes, obesity, and asthma. But whether depressive symptoms are a marker for or a cause of these conditions remains to be determined. What we do know is that the combination of depression and chronic disease greatly increases the risk of poor health outcomes.

Degrees of Depression

Depression is common. The latest figures suggest that 1 in 13 adults will experience at least one episode of major depression. Women seem to have a higher incidence of depression than men do, but men's symptoms tend to manifest as irritability, anger, and frustration and therefore may not always be recognized as signs of depression.

There are many different types of depression, including:

  • Dysphoria: Brief episodes of sadness or depression that last less than 2 weeks
  • Mild depression: Low-level depression that lasts at least 2 years (also called dysthymia)
  • Major depression: Intense, disabling depression that may occur in a single episode or recurring episodes
  • Seasonal affective disorder (SAD): Depression that occurs seasonally, specifically during winter, when there is less sunlight
  • Postpartum depression: Major depression that can develop in women after giving birth
  • Bipolar disorder: Cycles of severe depression alternating with an extremely elevated or irritable mood known as mania (also called manic depression)

Any number of events can set off an unpleasant emotional reaction that leads to a blue mood. But for some people, the sadness spirals into something deeper and may last for weeks or longer. This level of depression typically requires treatment by a professional healthcare provider.

However, if you experience a milder form of depression, you can take steps to defuse your negative feelings before they become debilitating and put your health at risk.

Start by taking a close look at three important areas of your life: your thought processes, your relationships, and your stress levels.

As you consider these areas of your life, assess how and why they influence your psyche on a daily basis, and begin to develop a plan to resolve any troubling issues.

1. Brighten Up Your Thinking

Pay more attention to your perceptions and reactions, and track them in a journal. Identify troublesome exchanges, and consider whether your emotional reactions -- to your boss, partner, family, or coworker, or to others -- were appropriate, or whether you may have overreacted. Keep in mind that emotions can twist how you see reality. Running through these events and evaluating them objectively can help you come up with healthier, more productive responses.

Example: Your boss snaps at you for missing a minor deadline.
Overreaction: You feel like a total failure or think to yourself, "I can't work with him. He's out to get me."
A more constructive reaction: Consider whether your boss may be having a stressful day himself, or resolve to make meeting your deadlines a higher priority in the future.

With practice, you'll be able to come up with more rational responses not only after the fact but also in the moment.

2. Build Supportive Relationships

How healthy are your relationships? Are you connected to a solid support group, or are you caught in friendships with people who take more than they give? Rate your mood after spending time with your close friends. If you consistently score low following outings with certain people, it's time to make some changes in those relationships. Negative social exchanges can affect your health even more than stressful life events or daily hassles.

If a friend has a habit of always pointing out mistakes you've made in the past or, knowing you're dissatisfied with your job, insists on talking about work, try telling her that you'd prefer to talk about what's positive in your life. If things don't change, limit the time you spend with her, and spend more time with friends who make you feel good about yourself.

Seek out positive people at work or in your community whom you admire and who will encourage and motivate you to take positive action and enjoy your life. Make time to chat with them at least once a week -- it could lift moderate depression as effectively as antidepressant medication or counseling.

Also, don't make the mistake of cutting out larger social engagements to accommodate a demanding schedule. Spending too much time alone puts you at risk of becoming overly self-focused and critical. Join a book club, sports team, or gardening club -- these are great ways to connect with people.

3. Simmer Down Stress

Some stress is good for you. It keeps you alert and active. But when it gets out of control, it can cause serious damage to your psyche and make you vulnerable to bouts of depression. So how can you keep yourself from getting too stressed out? Set aside at least 20 minutes every day to rest your mind. Turn off your phone, computer, and TV. Sit quietly and reflect on your favorite moments of the day. Or try picturing positive moments you'd like to have tomorrow.

Other ways to unwind: Practice yoga, go for a walk, read, pray, meditate, listen to a relaxation tape or music, or engage in any activity that clears your mind and releases tension. Try different techniques, like learning to meditate. See what works best for you, and then do it regularly.

Help When You Need It

Depression affects millions of Americans in varying degrees at some point in their lives. No matter what level, depression is a condition that requires management to keep episodes to a minimum. Before you get pulled back into another dark hole and struggle to climb out, do some self-reflection and make the changes that are necessary to help you maintain a positive frame of mind. These changes may give you the mental strength to manage your emotions before they escalate.

But if you feel down or depressed for more than 2 weeks, or your mood is interfering with everyday activities, you may need professional help to get back on track. The following two questions can help you determine if you'd benefit from a little extra help:

During the past month, have you often felt down, depressed, or hopeless?
During the past month, have you had little interest or experienced little pleasure in doing things?

If you answered yes to both of these questions, make an appointment with your doctor to find out whether you are suffering from clinical depression and need treatment.

If you answered yes to one of these questions, or feel uncertain about your mood, you may need to seek the advice of a medical professional.